Hi everyone. I'm so happy but at the same time confused. My neuro's assistant just called. ALL Evoked Potentials came back normal along with my Lumbar MRI showing only a mild bulge at L4/L5. So, this still doesn't explain my burning feet. He has two more tests he 'd like to check out and they are bloodwork to check for copper or zinc and a serolu plasmin (sp?) test. I couldn't understand what she said, even she didn't know how to pronounce it. Anyway, it's to check for levels of copper/zinc which can also cause my symptom.

Secondly, he's upping my Gabapentin since the 1pill 300 mg is not working. Now another thing about my blood sugars. I am not diabetic, however, I do have a monitor because I had Gestational Diabetes (6 years ago) and I am also at high risk for it. So, I do check it periodically and they have been higher now in the last week or so. I honestly don't know if it's the Gabapentin (which I started a month ago) causing my higher BS's or it's because I friggen gained 6 lbs. since taking it and now I am diabetic!!? Uggggh. My number last night 2 hours after eating was 176. Now, it was 126 this AM before breakfast. I was told to just keep an eye on it. Does anyone, first of all does Gabapentin (Neurotonin) make you gain weight and can it also raise BS's?

Thirdly, he said if I like, I can get a second opinion from a Dr. (he named him and where he's at), I could. Do I get a 2nd opinion? Sheesh, it's like he's offered it to me if I wanted to. However, I do feel comfortable with this doc and believe he's doing everything in his power to rule out MS (which he has!) This is what I have had so far that have ruled it out completely according to him.

Brain MRI (punctate areas of high signal intensity in Centrum Semiovale) - according to him Virchow-Robin Spaces and normal.
Cervical and Thoracic - MRI - No lesions but a mess with bulges and herniations.
Nerve Conduction Studies - Normal.
SSEP - Normal
VEP - Normal
BAEP - Normal
Lumbar MRI - Normal - but with a mild bulge at L4/L5.
Bloodwork: Lyme Titer, Lupus Panel, ANNA 1 and 2, VDRL, Immunoe/Extrophoresis, and B12

What do you think? Any advice appreciated. Especially about the 2nd opinion perhaps on the brain MRI which was done in early October. It's already been 3 months. Geese, I do not want MS, but I have this feeling deep down in the pit of my stomach it's either MS or Peripheral Neuropathy of some kind. However, he hasn't said he's completely ruled out PN, but what other tests for PN are there? I think I've had everything possible to rule out both of these conditions. I feel like I am at a loss to what I should call this evil thing I am feeling right now as I sit and type this, burning feet and now it's to the point it's not just when I sit, it's when I stand or even lay down. So, it's getting worse

Small fiber neuropathy is not usually picked up on any of those tests.

You can get a definitive answer with an epidermal nerve fiber density biopsy. If you want to know where to get one in your area, PM me.

--you haven't gotten anywhere near a complete work-up yet, though what you have is a decent start.

Cycelops is correct, but you may want to check out that diabetic possibility more closely. The numbers you report are borderline, and certainly fall into the category of imparied glucose tolerance, which is increasingly being recognized as a cause of neuropathy, especially painful small-fiber neuropathy (the type most typical in diabetics). In fact, it is now referred to in some literature as pre-diabetic neuropathy.

You should take a look also at the Liza Jane spreadhseets for neuro testing at www.lizajane.org. These are excellent not only for suggesting further testing, but for keeping track of test results/patterns over time.

You did mention that your upper spinal MRI's showed no lesions, but are a mess of herniations--is it possible that some pressure is being put on a nerve root or the cord there somewhere from those? You can get neural symptoms from nerve compression anywhere from the dermatome of that spinal level downwards--e.g., cervical cord problems can result in lower limb symtpoms, not just upper limb ones. (What exactly did those MRI's say--which brings up another point: do you have copies of all your test results/reports?)

Some stuff on impaired glucose tolerance as a cause of neuropathy:

http://millercenter.uchicago.edu/lea...diabetes.shtml

http://care.diabetesjournals.org/cgi...full/24/8/1448

http://care.diabetesjournals.org/cgi...full/29/6/1294

http://www.jabfm.org/cgi/content/full/17/2/127

The good news is that if prediabet'es is the cause of your nerve damage it is fully reversable, through a sensible diet and exercise, my PN was caused through prediabetes & i was low in b12 and now i am nearly healed.
I have seen many posts were people using Neurotin have stacked on the weight, i did try it first up myself but couldn't tolerant the med, but if i would really work at keeping your blood sugars to good levels, Glentaj is spot on. trouble is a lot of doc's don't think that prediabetes can cause PN, they think that you have to be a full blown diabetic for many years before any nerve damage happens which is not correct, depends on the individual, some full blown diabetic people don't get any nerve damage or it takes years but there is ever increasing evidence that SOME can get nerve damage in the early stages of diabetes when it's at borderline diabetes stage.
good luck
Brian

skin biopsy, as glenntaj recommends, PLUS, there are loads of bloodtests listed on www.lizajane.org, which you ought to print out and bring to your neuro for discussion. Most people have no problems getting their doctors to draw the bloods; they're generally happy to see the organized charts.

And keep copies of all your results.

Good luck.

I don't have PN but know a number of people who do, so I do have interest in it.

It seems so many go through test after test (and I guess necessary to not miss something) before finally calling it PN.

But not knowing still doesn't address the pain. Have the doctors provided anything to at least help in getting some relief of the pain?

Ron

Everyone above has already posted a lot of information, so I don't have much to add. My feet are burning tonight though, and I have/may have/don't know if I have or not-Sjogren's...

You know, I take injectible B12 every week and it seems to help with the burning... You might want to try it. It won't hurt you. It is water soluble and your body just uses it if you need it and eliminates it in urine if it is not needed. A number of people I know are using this for PN pain...

Good luck,
Cathie